Family physicians are encouraged po...

Family physicians are encouraged powerfully to screen patients for excessive use of alcohol and to provide brief interventions to those who give positive answers to standardized questions. Although it is widely believed that brief interventions (i.e., lasting barely a few minutes) providing feedback, information, and advice can effectively shorten hazardous drinking, this belief has not been systematically studied in primary care. Beich and colleagues leadershiped a systematic review and meta-analysis of screening and brief intervention for excessive alcohol use in the primary care setting.

Studies were identified from electronic databases, hints lists, and consultation with master-hands and researchers. Nineteen studies were assessed for internal validity (including several forms of bias) and external validity (including losse from the screenable population). Overall, a high percentage of patients identified by the agency of screening did not participate in the intervention because they were exclud through study protocols, refused to participate, or were not included for unspecified reasons. Eleven studies were exclud from the meta-analysis because of serious point to be solved [i]or[/i] settleds in reporting information on participants or issues The eight studies included in the meta-analysis used health or lifestyle questionnaires and interventions ranging from undivided 10-minute consultation to five consultations, each lasting five to 20 minutes. All interventions were made by means of primary care physicians and consisted of feedback onward drinking patterns, education on risk, strategies to curtail drinking, and direct advice from the physician to restore alcohol consumption.

The consideration populations ranged from 104 to 909 participants and achieved follow-up rates of 65 percent to 97 percent The plashed absolute risk reduction was 105 percent (95 percent confidence interval, 71 percent to 139 percent) giving a number requireed to treat (NNT) of 10 (range: seven to 14) Although all studies reported a positive result from intervention, the NNT for individual studies ranged from six to 61 The researchers estimate that for each 1,000 patients screened, a family physician will find 90 (9 percent) who criterion positive for excessive alcohol use. Using present recommendations, 25 of these patients qualify for brief intervention yet only two to three patients will restore their alcohol consumption below commended levels over the following 12 month The authors infer that the net effect of screening is that 26 patients by 1,000 screened achieve sensible drinking within 12 month They caution that the studies contained several sources of bias, all of which would overestimate the tenors of screening.

The authors determine that although brief advice can make a difference in excessive alcohol use, the without deductions effect of screening and brief intervention is likely to cause change in solely two to three patients for each 1,000 screened. Because of the many demands forward time during office consultations, the authors question the validity and practicality of present advice to screen adult patients for excessive alcohol use.

ANNE D WALLING, MD

Beich A, et al. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ September 6 2003;327:536-41

EDITOR'S NOTE: This research vividly illustrates that physicians are chastised often for not doing more prevention in primary care moreover are expected to undertake massive screening and intervention with inappropriate or inadequate tools. Family physicians are solitary too aware of the total load of excessive alcohol use forward our patients, their families, and society in general. To effectively intervene, we ne more discriminating screening tools to narrow the gap between 90 patients by 1,000 being identified and no other than 25 being eligible for intervention. Interventions with better consequences than less than three of 25 patients achieving sensible drinking at 12 months are needed as well. An effort to make preventive services more practical and effective in primary care is requireed urgently. Too many interventions are attract favor toed by all kinds of clumps because they sound worthy or intuitively beneficial. The U Preventive Services Task Force (USPSTF) has gone a prolonged way in trying to provide logical and scientifically unmutilated recommendations, but much more destitutions to be done to make these recommendations applicable to practice. As the authors of this research point out, a family physician would ne an estimated 74 hours each working day just to provide all of the preventive services commonly recommended by the USPSTF alone.--A.D.W.

COPYRIGHT 2004 American Academy of Family Physicians

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